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NON-TOXIC INGESTION

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Non-toxic ingestion is consumption of a product that does not usually produce symptoms. Although some products may be labeled as non-toxic in this management, a patient can potentially have a non-dose-related life-threatening effect such as a hypersensitivity reaction to any substance, and be at risk of foreign body obstruction and aspiration.

Specific Substances

    1) Ingestion, non-toxic

Available Forms Sources

    A) SOURCES
    1) Although some products may be labeled as non-toxic in this management, a patient can potentially have a non-dose-related life-threatening effect such as a hypersensitivity reaction to any substance, and be at risk of foreign body obstruction and aspiration (Kearney et al, 2006).
    2) The following is a partial list of materials that have been ingested and GENERALLY have not produced significant acute toxicity except in large doses (McGuigan, 2003); Weisman, 1998; (Ellenhorn & Barceloux, 1988; Everson et al, 1988) Mofenson et al, 1984 Mofenson & Greensher, 1970):
    1) Abrasives
    2) Acacia (chemistry sets)
    3) A&D ointment
    4) Antacids nonsalicylate (excluding magnesium or sodium bicarbonate products)
    5) Antibiotics, topical
    6) Antifungals, topical
    7) Baby product cosmetics
    8) Ballpoint pen inks
    9) Bathtub floating toys
    10) Body conditioners
    11) Calamine lotion (without antihistamines or local anesthetics)
    12) Calcium sulfate (chemistry sets)
    13) Candles (beeswax or paraffin)
    14) Carboxymethyl cellulose
    15) Cat food
    16) Chalk (calcium carbonate)
    17) Charcoal (chemistry sets)
    18) Clay (modeling)
    19) Contraceptives, oral (non-iron)
    20) Corticosteroids, topical with antibiotics
    21) Cosmetics
    22) Crayons (marked A.P., C.P.)
    23) Dehumidifying Packets (silica or charcoal)
    24) Detergents, hand dishwashing
    25) Deodorants
    26) Deodorizers (spray and refrigerator)
    27) Diaper rash creams and ointments
    28) Elmer's Glue
    29) Etch-A-Sketch
    30) Eye Makeup
    31) Fabric softeners, solid sheets
    32) Feces
    33) Felt-tip pens (water base)
    34) Fire extinguishers
    35) Fish bowl additives
    36) Fish food
    37) Glow products
    38) Glues and pastes (water soluble)
    39) Glycerol
    40) Golf ball (core may cause mechanical injury)
    41) Greases
    42) Gums
    43) Hair products (dyes, sprays, tonics)
    44) Incense sticks
    45) Indelible markers
    46) Ink (black, blue)
    47) Ion exchange resin (chemistry sets)
    48) Iron filings (chemistry sets)
    49) Kaolin
    50) KY Jelly
    51) Lanolin
    52) Linoleic Acid
    53) Linseed Oil
    54) Lip balm (without camphor)
    55) Lipstick
    56) Logwood (chemistry sets)
    57) Lubricant
    58) Lubricating oils
    59) Magic Markers
    60) Magnesium Silicate
    61) Makeup (eye, liquid facial)
    62) Newspaper
    63) Paint - indoor or Latex
    64) Paraffin
    65) Pencil (lead-graphite, coloring)
    66) Petroleum jelly (Vaseline)
    67) Plant food, household
    68) Play-Doh
    69) Polaroid picture coating fluid
    70) Porous-tip ink-marking pens
    71) Prussian Blue (ferricyanide)
    72) Putty (less than 2 oz.)
    73) Rouge
    74) Sachets (essential oils, powder)
    75) Sesame Oil
    76) Shaving cream
    77) Shoe polish (most do not contain aniline dyes)
    78) Silica
    79) Silly Putty (99% silicones)
    80) Sodium iodide (chemistry sets)
    81) Spackles
    82) Starch/sizing
    83) Suntan preparations
    84) Sweetening agents (saccharin, cyclamate)
    85) Teething rings (water-sterility?)
    86) Thermometers (mercury)
    87) Throat lozenges (without local anesthetics)
    88) Titanium Oxide
    89) Tooth paste (without fluoride)
    90) Urine
    91) Vaseline
    92) Water colors
    93) Zinc Oxide
    94) Zirconium Oxide

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: This document describes the management of substances generally considered nontoxic. Careful identification of the exact substance is critical for the appropriate application of the recommendations included in this document. These substances may still cause significant health effects due to idiosyncratic or allergic reactions, acting as a foreign body, or when the exposure is massive.
    B) TOXICOLOGY: The most common effects are mucosal irritation or injury or gastrointestinal tract irritation.
    C) EPIDEMIOLOGY: Ingestions of nontoxic substances are very common. More than mild effects suggest misidentification of the product or massive exposure.
    D) WITH POISONING/EXPOSURE
    1) The most common effects are mucosal irritation or injury or gastrointestinal tract irritation. Aspiration or upper airway obstruction from a foreign body are also possible.
    0.2.22) OTHER
    A) A nontoxic ingestion occurs when the victim consumes an inedible product that usually does not produce symptoms. The importance of knowing that a product is nontoxic is that overtreatment is avoided and, more importantly, the victim and parents are not placed in the jeopardy of a panicky automobile ride to the physician or nearest hospital (Comstock, 1978).
    B) Although some products may be labeled as nontoxic in this management, a patient can potentially have a non-dose-related life-threatening effect such as a hypersensitivity reaction to any substance, and be at risk of foreign body obstruction and aspiration (Kearney et al, 2006).
    C) Materials referenced to this management have been considered very unlikely to produce any toxicity except in enormous doses. For example, ballpoint pen cartridges, even if sucked completely dry by a child, do not contain enough toxic materials to cause illness (Mofenson et al, 1984).
    D) While almost anything, including water and table salt, may cause illness if taken in excessive amounts or by other than the normal route, normal exposures from these products would not be expected to produce toxicity (Horev & Cohen, 1994).
    E) Some agents are harmful in manners different from that expected. A broken thermometer is dangerous not from the inert metallic mercury, but from the broken glass (Mofenson et al, 1984). Most patients calling are more worried about mercury, which they think of as poison, than the glass.
    F) General guidelines for determining whether an exposure can be categorized as nontoxic (reviewed in Weisman, 1998; (Mofenson et al, 1984):
    1) Absolute identification of the product, its ingredients, and its concentration.
    2) Absolute assurance that only the identified product was involved in the exposure.
    3) The exposure must be unintentional.
    4) "Signal words" identified by the Consumer Product Safety Commission (eg, Caution, Warning, Danger) must not be found on the label.
    5) A reliable approximation of the quantity of the substance involved in the exposure.
    6) The route of exposure can be assessed accurately from the patient's available history.
    7) Following the exposure, the patient is symptom-free.
    8) A follow-up consultation with the patient must be possible. In the case of a pediatric exposure, the parent must appear to be reliable.

Laboratory Monitoring

    A) In general, laboratory testing is not needed. If the patient has more than mild symptoms, testing should be directed at evaluation of the symptoms.
    B) Radiographs may be required to evaluate for retained objects, but many objects are not radio-opaque. Contrast studies may be used in some cases.
    C) Patients with symptoms suggesting gastrointestinal obstruction or perforation should have CT scan imaging.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Primarily supportive care. If the patient has oral irritation, they should rinse their mouth. Patients with persistent vomiting may require IV fluids.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Severe toxicity suggests that the exposure was misidentified, idiosyncratic reactions (eg, allergic), or massive exposure. In these situations, management should be supportive and directed at the specific symptoms. Administer oxygen and obtain a chest radiograph if aspiration is suspected.
    C) DECONTAMINATION
    1) Patients who have oral irritation should rinse their mouths with water.
    D) AIRWAY MANAGEMENT
    1) If a non-toxic substance has been aspirated or causes upper airway obstruction, airway management may be necessary.
    E) ANTIDOTE
    1) None
    F) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients with exposure to a known non-toxic product and who have no more than mild symptoms may be managed at home.
    2) OBSERVATION CRITERIA: Patients with self-harm ingestions or children in whom abuse or neglect are concerns should be referred to a healthcare facility for evaluation.
    3) ADMISSION CRITERIA: Admission is almost never necessary unless aspiration or airway obstruction have occurred.
    4) CONSULT CRITERIA: Toxicologist should be consulted if there is a question of possible systemic toxicity.
    G) PITFALLS
    1) Severe toxicity following exposure may suggest possible misidentification of the product.
    0.4.3) INHALATION EXPOSURE
    A) Although inhalation of common dust may not be considered toxic, it is certainly a hazard if there is inhalation of too many particles. Individuals should be removed from exposure to too high a concentration of even relatively nontoxic substances.
    0.4.4) EYE EXPOSURE
    A) Foreign materials in the eye may not cause a toxic reaction, but injury from a foreign body may occur. In such cases, the patient should be observed for eye irritation and should seek medical assistance if the irritation becomes significant.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) Foreign materials spilled on the skin may not represent a toxic or irritation hazard in small quantities but may produce adverse effects if applied in large quantities or if used over a significant period of time. Whenever possible, foreign materials should be removed from the skin with simple washing. Should skin irritation or erythema occur, a patient may wish to seek medical assistance.

Range Of Toxicity

    A) These agents are considered not to be a toxic hazard in the quantities available through normal exposure or package size.

Clinical Effects

Summary Of Exposure

    A) USES: This document describes the management of substances generally considered nontoxic. Careful identification of the exact substance is critical for the appropriate application of the recommendations included in this document. These substances may still cause significant health effects due to idiosyncratic or allergic reactions, acting as a foreign body, or when the exposure is massive.
    B) TOXICOLOGY: The most common effects are mucosal irritation or injury or gastrointestinal tract irritation.
    C) EPIDEMIOLOGY: Ingestions of nontoxic substances are very common. More than mild effects suggest misidentification of the product or massive exposure.
    D) WITH POISONING/EXPOSURE
    1) The most common effects are mucosal irritation or injury or gastrointestinal tract irritation. Aspiration or upper airway obstruction from a foreign body are also possible.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) In general, laboratory testing is not needed. If the patient has more than mild symptoms, testing should be directed at evaluation of the symptoms.
    B) Radiographs may be required to evaluate for retained objects, but many objects are not radio-opaque. Contrast studies may be used in some cases.
    C) Patients with symptoms suggesting gastrointestinal obstruction or perforation should have CT scan imaging.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Admission is almost never necessary unless aspiration or airway obstruction have occurred.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients with exposure to a known non-toxic product and who have no more than mild symptoms may be managed at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Toxicologist should be consulted if there is a question of possible systemic toxicity.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with self-harm ingestions or children in whom abuse or neglect are concerns should be referred to a healthcare facility for evaluation.

Monitoring

    A) In general, laboratory testing is not needed. If the patient has more than mild symptoms, testing should be directed at evaluation of the symptoms.
    B) Radiographs may be required to evaluate for retained objects, but many objects are not radio-opaque. Contrast studies may be used in some cases.
    C) Patients with symptoms suggesting gastrointestinal obstruction or perforation should have CT scan imaging.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Dermal exposures should be washed with soap and water. Patients who inhale non-toxic fumes should be taken to fresh air. Patients who have oral irritation should rinse their mouths with water.
    6.5.2) PREVENTION OF ABSORPTION
    A) Patients who have oral irritation should rinse their mouths with water.
    6.5.3) TREATMENT
    A) SUPPORT
    1) Even though a substance may be considered nontoxic for the amount ingested or packaged, it should not be considered nontoxic in any amounts. Even ingestions of various foodstuffs can cause adverse symptoms if large amounts are eaten (eg, green apples, garlic, onion).
    2) The most important fact to remember is to treat the patient, not the poison, especially when the diagnosis is unknown.
    B) MONITORING OF PATIENT
    1) In general, laboratory testing is not needed. If the patient has more than mild symptoms, testing should be directed at evaluation of the symptoms.
    2) Radiographs may be required to evaluate for retained objects, but many objects are not radio-opaque. Contrast studies may be used in some cases.
    3) Patients with symptoms suggesting gastrointestinal obstruction or perforation should have CT scan imaging.

Range Of Toxicity

Summary

    A) These agents are considered not to be a toxic hazard in the quantities available through normal exposure or package size.

References

General Bibliography

    1) Comstock EG: Morbidity due to non-poisoning. J Occup Med 1978; 20:755-758.
    2) Ellenhorn MT & Barceloux DG: Medical Toxicology: Diagnosis and Treatment of Human Poisoning, Elsevier, New York, NY, 1988.
    3) Everson GW, Normann SA, & Casey JP: Chemistry set chemicals: An evluation of their toxic potential. Vet Hum Toxicol 1988; 30:589-592.
    4) Horev Z & Cohen AH: Compulsive water drinking in infants and young children. Clin Pediatrics 1994; 209-213.
    5) Kearney TE, VanBebber SL, Hiatt PH, et al: Protocols for pediatric poisonings from nontoxic substances: are they valid?. Pediatr Emerg Care 2006; 22(4):215-221.
    6) McGuigan MA : Guideline for the out-of-hospital management of human exposures to minimally toxic substances. J Toxicol Clin Toxicol 2003; 41(7):907-917.
    7) Mofenson HC, Greensher J, & Caraccio TR: Ingestions considered nontoxic. Clin Lab Med 1984; 4:587-602.